What effect does alcohol have on your health — and your liver?

During the COVID-19 pandemic, national alcohol sales have increased 54%. A national survey in the September 2020 issue of JAMA revealed that people 18 and older were consuming alcohol more often. Another 2020 survey reported that people experiencing stress related to COVID-19 were drinking more alcohol and consuming it more often.

While the pandemic has increased alcohol use, this isn't a new concern. Alcohol use disorders are among the most common substance use disorders worldwide.

The 2019 National Survey on Drug Use and Health reveals that in the U.S.:

• Nearly 15 million people 12 and older had alcohol use disorder.
• Of people 18 and up, 85.6% reported they consumed alcohol at some point in their life.
• In adults, 25.8% reported binge drinking and 6.3% reported heavy alcohol use in the past month.
• For those 12 to 20, 7 million people, or 18.5% of this age group, reported drinking alcohol in the past month.

Effect on overall health, well-being

Consuming alcohol can significantly affect your health, as well as your overall well-being and safety. Alcohol is the third-leading preventable cause of death in the U.S., with 95,000 people dying each year from alcohol-related causes.

Between 2011 and 2015, the leading causes of death due to alcohol-related chronic conditions were:

• Liver disease, including cirrhosis and cancer
• Heart disease, abnormal heart rhythms, hypertension and stroke
• Oral and upper digestive tract cancers
• Breast cancer
• Alcohol use disorder

Long term, alcohol use can increase the risk of developing certain cancers, including colon, liver, esophagus, mouth and breast. Also, drinking alcohol doesn't protect from COVID-19 infection, since alcohol weakens the immune system and makes it difficult for the body to fight infections.

Alcohol's affect extends beyond illness. People who consume alcohol at twice the binge drinking threshold ― that's five or more drinks for men and four or more for women in about two hours ― are 70 times more likely to have an alcohol-related emergency department visit. Alcohol-impaired driving fatalities accounted for one-third of all driving fatalities in 2019. The consequences of underage drinking include unintentional injuries; sexual assaults; alcohol overdose; and deaths, including motor vehicle crashes.

Effect on your liver

Excessive alcohol consumption can significantly affect the liver and contribute to three types of liver disease:

• Excessive buildup of fat in the liver, also known as fatty liver or hepatic steatosis
• Inflammation of the liver or alcoholic hepatitis
• Replacement of normal liver tissue by scared tissue or alcohol-related cirrhosis

Fatty liver

Almost all heavy drinkers develop fatty liver, which is the earliest stage of alcohol-related liver disease. Most people with fatty liver don't have symptoms, although they can have an enlarged liver or mild discomfort in the upper right side of the abdomen. This is a preventable disease, and it's reversible if treated early. The best treatment is for the patient to stop drinking.

Alcoholic hepatitis

About one-third of heavy drinkers develop alcoholic hepatitis, where the liver become inflamed and swollen, and liver cells are destroyed. This hepatitis varies in severity from mild to severe, and patients may have jaundice, fever, nausea and vomiting, and abdominal pain. The mild form can last for years and lead to more liver damage, unless the patient stops drinking. Severe alcoholic hepatitis occurs suddenly, usually after binge drinking, and it can be life-threatening. The only way to possibly prevent this hepatitis from worsening and improving life expectancy is to stop drinking.

Cirrhosis

Of heavy drinkers, 10%–20% develop cirrhosis, a serious condition that usually develops after 10 or more years of drinking. Because scar tissue builds up and replaces most of the liver cells, it's irreversible. While patients with early cirrhosis may not have any symptoms, this condition tends to progress and significantly damage the liver before it's detected.

Over time, patients develop:

• Fatigue, weakness and muscle wasting
• Increased pressure in the liver
• Accumulation of fluids in the abdomen and legs
• Bleeding from veins of the esophagus
• Confusion, decreased concentration and changes in behavior
• Enlarged spleen

Cirrhosis can lead to fatal liver failure or liver cancer. At this point, some patients may benefit from a liver transplant if they meet certain criteria. Complete abstinence from alcohol use is important.

Is there a safe level of drinking?

While moderation is key, it's a good idea for patients to review their alcohol use with their health care provider. How people react to the adverse effects of alcohol varies depending on age, gender, genetic background and other medical issues. Women tend to develop liver disease faster than men, despite consuming the same amount of alcohol over the same length of time.

Beer and wine are not safer than spirits. Alcohol is alcohol, regardless of the type. One standard drink is equivalent to 12 ounces of beer, five ounces of wine or 1.5 ounces of spirits. All have the same amount of alcohol.

For patients without liver disease:

• Moderate drinking is two drinks per day for men and one per day for women.
• Higher-risk drinking is three or more drinks per day for men and two or more drinks for women.
• Binge drinking is defined as consumption of five or more drinks within two hours for males or at least four drinks for women.

If you're concerned about the effects of alcohol use on your health, contact your health care provider for help. Your provider also may refer you to a liver clinic, such as the one at Mayo Clinic Health System in Mankato or Mayo Clinic in Rochester, Minnesota, for further evaluation and management of alcohol-related liver disease.

Omar Mousa, M.B.B.S., M.D., practices gastroenterology and hepatology (digestive and liver care) in Mankato, Minnesota. He is affiliated with the Liver Transplant Program at Mayo Clinic in Rochester.